Data released in April suggest the theory behind second-generation sphingosine 1-phosphate receptor agonists in development for multiple sclerosis was wrong. However, two companies are finding that improved pharmacokinetics and/or dose titration could achieve the original goal of improving safety compared with first-generation S1P receptor agonist Gilenya fingolimod from Novartis AG.

Gilenya, the first oral drug for relapsing-remitting multiple sclerosis (RRMS), was approved in September 2010, but has struggled to gain a foothold in first-line use due to concerns over cardiovascular safety (see BioCentury, Sept. 27, 2010).